上海市 HIV/TB 合并感染患者早期死亡率的回顾性队列研究。

A retrospective cohort study of early mortality among patients with HIV/TB co-infection in Shanghai municipality.

机构信息

Department of Infectious Diseases and Immunology, Shanghai Public Health Clinical Center, Shanghai, China.

出版信息

HIV Med. 2020 Dec;21(11):739-746. doi: 10.1111/hiv.13025.

DOI:10.1111/hiv.13025

PMID:33369033

Abstract

OBJECTIVES

Tuberculosis (TB) is the most common and fatal opportunistic co-infection among HIV-infected individuals. While TB-associated mortality predominantly occurs in the first 90 days after admission, such a correlation remains unclear in HIV/TB co-infected patients. Thus, we aimed to investigate the 90-day mortality and associated risk factors among HIV/TB co-infected patients in China.

METHODS

Adult patients with HIV and a newly confirmed TB diagnosis admitted to the Shanghai Public Health Clinical Center between September 2009 and August 2017 were enrolled. Clinical and laboratory characteristics, key treatments and outcomes were collected retrospectively. The associations between different factors and early mortality were analysed.

RESULTS

Of the 485 laboratory-confirmed HIV/TB patients [median (range) age = 39 (19-79) years], 413 (85.15%) were male. Diagnosis was confirmed by culture, pathology and acid-fast bacilli smear alone in 362 (74.6%), 6 (1.2%) and 117 (24.1%) patients, respectively. Multiple drug-/rifampin-resistant TB was detected in 21 (5.8%) of the 367 patients with a positive culture. Rifampin or rifabutin was administered to 402 (82.9%) patients. Additionally, 66 (13.6%) and 86 (17.7%) died within 90 days and 1 year of admission, respectively. Of the 64 TB-related deaths, 59 (92.2%) occurred within 90 days of admission. In Cox regression, central nervous system (CNS) TB [odds ratio (OR) = 2.49, 95% confidence interval (CI): 1.46-4.23, P < 0.001], no antiretroviral therapy (ART) within 3 months after admission (OR = 11, 95% CI: 6.4-18.9, P < 0.001), and plasma albumin level < 25 g/L (OR = 1.91, 95% CI: 1.07-3.40, P = 0.021) were associated with early death.

CONCLUSIONS

Tuberculosis co-infection was prevalent and fatal in HIV-infected patients, with most deaths occurring within 90 days of admission. Early mortality was associated with CNS-TB, no ART, and serum albumin level < 25 g/L.

摘要

目的

结核病（TB）是 HIV 感染者中最常见和最致命的机会性合并感染。虽然与 TB 相关的死亡率主要发生在入院后 90 天内，但 HIV/TB 合并感染患者的这种相关性尚不清楚。因此，我们旨在研究中国 HIV/TB 合并感染患者的 90 天死亡率和相关危险因素。

方法

纳入 2009 年 9 月至 2017 年 8 月期间在上海市公共卫生临床中心住院的 HIV 阳性且新确诊为结核病的成年患者。回顾性收集临床和实验室特征、关键治疗和结局。分析不同因素与早期死亡率的关系。

结果

485 例实验室确诊的 HIV/TB 患者[中位（范围）年龄=39（19-79）岁]中，413 例（85.15%）为男性。362 例（74.6%）、6 例（1.2%）和 117 例（24.1%）患者分别通过培养、病理学和抗酸杆菌涂片确诊。在 367 例培养阳性的患者中，有 21 例（5.8%）检测到多种药物/利福平耐药性结核病。402 例（82.9%）患者给予利福平或利福布汀治疗。此外，分别有 66 例（13.6%）和 86 例（17.7%）患者在入院后 90 天内和 1 年内死亡。在 64 例与结核病相关的死亡中，59 例（92.2%）发生在入院后 90 天内。在 Cox 回归中，中枢神经系统（CNS）结核病[比值比（OR）=2.49，95%置信区间（CI）：1.46-4.23，P<0.001]、入院后 3 个月内未接受抗逆转录病毒治疗（ART）（OR=11，95%CI：6.4-18.9，P<0.001）和血清白蛋白水平<25 g/L（OR=1.91，95%CI：1.07-3.40，P=0.021）与早期死亡相关。